Long-term results of sleeve lobectomy for lung cancer

Objective: Sleeve lobectomy is a lung saving procedure indicated for central tumors for which the alternative is a pneumonectomy. Current controversies relate to the safety of the procedure and adequacy as a cancer operation. The aim of the study is to analyze long-term survival after sleeve lobectomy, particularly in relation with nodal status and histological type. The incidence and patterns of recurrences were reviewed. Methods: From 1972 to 1998, 184 patients (male 152, female 32) underwent sleeve resection for lung cancer. The mean age was 60 +/- 10 years (11-78 years), and the indications for operation were a central tumor (79%), peripheral tumor with nodal involvement (13%) and compromised pulmonary function (8%). The histological type was predominantly squamous (n = 125, 68%), followed by nonsquamous (n = 50, 27%) and carcinoid tumors (n = 9, 5%). Resection was complete in 161 patients (87%). Results: The operative mortality was 1.6% (n = 3). Follow-up was complete for the remaining 181 patients (mean, 5.7 years; range, 1 month-26 years). The survival at 5 and 10 years of all patients was 52 and 33%, respectively. Theses rates for patients with N0 status (n = 97) were 63 and 48%, and 48 and 27% For those with N1 status (n = 68: N0 vs. N1, P < 0.05). An 8% survival rate was observed with N2 status (n = 19) at 5 years, with no survivors after 7 years of follow-up. The 5 and 10 year survival was 56 and 34% for squamous carcinoma vs. 33 and 22% for non-squamous carcinoma (P < 0.05). These rates were 58 and 38% for complete resection vs. 11 and 6% for incomplete resection at 5 and 10 years, respectively (P < 0.05). Local recurrences occurred in 22% of cases,and the prevalence was statistically different between patients with N0 disease (14%) and N1 disease (23%, P = 0.03), but not between N1 and N2 disease (42%; P = 0.2). When local and distant recurrence were pooled together, the differences were highly significant between N0 (22%) and N1 (41%) disease (P = 0.007), and between N0 and N2 (63%) disease (P = 0.0002), but not between N1 and N2 disease (P = 0.09). Conclusion: Sleeve lobectomy is a safe and effective therapy for patients with resectable lung cancer. The presence of N1 and N2 disease, or of non-squamous carcinoma significantly worsen the prognosis. (C) 2000 Elsevier Science B.V. All rights reserved.